State Programs
Most states have some type of state funded insurance program. These are open to families who have children with handicapping conditions. The Ohio Bureau for Children with Medical Handicaps (BCMH), the Kentucky Commission for Children with Special Health Care Needs and Indiana Services for Children with Special Health Care Needs are all state funded programs in this area. Eligibility is usually based on four items:
- Age (0-21 years)
- Proof of state residency
- Proof of chronic, treatable rheumatic condition
- Family income and ability to pay
Usually these plans help families to first identify third party resources such as health insurance and Medicaid. Families are required to utilize other benefits first, when they are available.
- Ohio Bureau for Children with Medical Handicaps (BCMH)
This program is available for Ohio residents by the Ohio Department of Health. It helps children under age 21, who have potentially handicapping conditions or actual handicapping conditions. These children must be seen by doctors and facilities which are approved by BCMH through their certification program.
Questions about BCMH may be answered by calling 800-755-GROW (4769) or 614-466-1700. Written correspondence should be sent to:
Bureau for Children With Medical Handicaps
P.O. Box 1603
Columbus, Ohio 43266
There are two (2) broad program categories:
- Diagnostic:
Regardless of family income, families are eligible to receive services for a minimum of three months but no more than six months. These services could include doctor visits, laboratory tests, x-rays, and limited hospital stays. Ask a rheumatology social worker about applying during the first clinic visit. All applicants are approved; there is no fee or financial disclosure needed. Approval through this program usually covers insurance copayments and deductibles. This program may pay the entire cost for diagnostic services if a family does not have any insurance or other assistance programs at the time of service. - Treatment:
Children with a diagnosis of a rheumatic disease who are in need of ongoing services through the Rheumatology clinic are eligible for this part of the BCMH program. Their families must be financially eligible. Covered services include hospitalizations, surgery, physician visits, lab tests, medicine, x-rays, wheelchairs, leg braces, splints, etc. Families must submit an application with financial information. Also, the rheumatology social worker will complete a form and submit it to the BCMH main office in Columbus, Ohio. This approval process takes about ninety (90) days. Continuing the program is based on annual or biannual evaluations.
Kentucky Commission for Children with Special Health Care Needs:
This program is similar to BCMH. However, it only covers services for children diagnosed with specific rheumatologic conditions, e.g., JRA, dermatomyositis, systemic lupus erythematosus, scleroderma, and ankylosing spondylitis. Other diagnoses are determined on a case-by-case basis. Families are referred to an office in or near their community to apply once a definite diagnosis of one of the above diseases is made. Financial eligibility is determined on the basis of the estimated cost of the treatment services to be provided. Also, the family's ability to pay will be considered. Each clinic visit, procedure, laboratory test, and x-ray must be authorized before each patient visit.
Questions about the Kentucky Commission for Children with Special Health Care Needs may be answered by calling 1-800-232-1160 or writing to:
Commission Headquarters
982 Eastern Parkway
Louisville, KY 40217-1597
Patients in Northern Kentucky should call the Coordinator at 888-54-CHILD or 859-578-5135. Indiana Children with Special Health Care Services (CSHCS):
Services include inpatient and emergency services, durable medical equipment, supplies, x-rays, lab services, surgery, and therapies.
To apply, contact the Indiana County Department of the Family Social Services Administration, Division of Families and Children, or one of 8 CSHCS administrative offices throughout Indiana. Applicants must also apply for the Indiana Medicaid Program. If accepted, a case manager is assigned to coordinate your child's medical care and authorization of services.
For more information call the Indiana Family Helpline at 1-800-475-1355.
In order to be eligible for this program, children must have an arthritic condition that:
Has lasted or is expected to last for at least 2 years, if not treated Needs more health care services than are usually required for a child of their age Will lead, without intervention, to a chronic disabling condition within 1 yearHigh Risk Sharing Pools are offered by some states. At this time, Ohio does not have high risk pools. These plans cover persons who are unable to get insurance through any of the above services. Usually, these plans are expensive and may have limited coverage. If your family cannot buy insurance (due for example, to a pre-existing condition), high risk pools may meet your needs. Additional information can be obtained from your state's department of insurance.For more information about the William S. Rowe Division of Rheumatology at Cincinnati Children's, please contact 513-636-4676.
